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Denied Claims Blog

As Boy Fights for His Life, Insurance Fights Not to Pay

December 16, 2013

Brandon Schmidt is 19. He wants to see the world. Instead, the teen is fighting for his life against cystic fibrosis from his home in Paradise, Calif.

Diagnosed at 4 months old, Brandon has undergone therapies since the age of 15. His lungs have collapsed 8 times, and he relies on large oxygen tanks to breathe. To save his life and give him a chance at fulfilling his dreams, Brandon needs a double lung transplant, a local TV station reported.

Resistance from Hospitals and Insurance

As Brandon struggles to breathe, his family is fighting for the life-saving procedure. Hospitals are hesitant to perform the surgery due to the risk of complications. The family is trying to schedule a consultation with UC San Francisco in hopes that the medical center will agree to do the surgery.

There is, however, another problem. The surgery would cost more than $400,000, and the family’s insurance provider is refusing to cover it. Insurance companies have also denied claims to cover the consultations for the transplant.

Insurance policies come with a myriad of exclusions and may also have lifetime benefit caps — meaning that they are only responsible for health care up to a certain amount. They also refuse to cover anything not deemed medically necessary or anything classified as experimental.

The reasons for the denials for Brandon’s surgery were not disclosed, but the family has a lawyer who has volunteered to look into them. In the meantime, the family is doing their best to raise the funds for the upcoming consultations, which cost $500 a day. They are raffling off family jewelry, holding a bake sale and hope to start up a 5K race.

Insurance Will Deny Legitimate Claims to Save Money

Insurance companies are concerned primarily with their bottom line. If they can get away with denying a legitimate claim, they will. For such an expensive procedure, insurance companies will find any and all reason to issue a denial. Figuring out how to get a claim covered can be a frustrating and financially stressful ordeal. If your insurance has denied a claim that should be covered, please contact us immediately.

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